Medicaid: Common Questions & Answers
Q. How do I apply for Medicaid?
A. Please contact your local Boulder County Social
Services office to determine Medicaid eligibility.
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Longmont: 303-678-6000
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Louisville: 303-413-7000
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Boulder: 303-441-1000
Or you may visit
Colorado Department of Health Care Policy and Financing to download a
joint Medicaid/CHP+ Please note: The application
cannot be submitted online. You must turn in your
application at the local county Department of Social
Services in the county in which you reside.
For more information on Medicaid programs:
Q. Are there other health care coverage options
available through the state for my child(ren)?
A. Yes. Child Health Plan Plus (CHP+).
About CHP+:
CHP+ is a low-cost health insurance
program for uninsured Colorado children ages 18 and under
whose families earn too much to qualify for Medicaid but
cannot afford private insurance. CHP+ also offers benefits
to pregnant women. The CHP+ Prenatal Care Program offers
low-cost health insurance to uninsured Colorado pregnant
women who live in households that meet certain income
requirements. For more information about CHP+, call
1-800-359-1991 or visit
www.CHPplus.org.
Q. Whom should I call when my child's doctor is not available?
A. Medicaid clients have a registered nurse (RN) available to advise
them about their children's health and what to do.
Please contact FirstHelp Nurse
Triage Line at 1-800-283-3221 (available 24 hours a day, 7 days a week).
Additional resources:
Q. If my child needs to see a specialist, do I need a referral from my child's
doctor?
A. Medicaid requires that some services must
first be approved before receiving them. This process is called prior authorization and starts with the primary care
provider (PCP) or child's doctor completing a form and sending it to Medicaid. This document allows Medicaid to decide
the service is medically necessary and if
they will pay for that specific service or item. A referral is never needed
from your physician to see a dentist, eye doctor, a Medicaid mental or
behavioral health provider, family health planning, or hearing services.
NOTE: The screenings
(well-child exams) are the key to opening the door to other services or benefits
of EPSDT Medicaid.
Q. How do I know which dentists or eye
doctors take Medicaid?
A. You can call your local EPSDT outreach specialist for a listing of providers
in your area. It is important to note that additional documentation and/or letters of
medical necessity are sometimes needed to assist Medicaid in approving the
request for a benefit or service.
For a list of Medicaid providers:
Q. What if I want to change the PCP or HMO listed on my Medicaid card?
A. You will need to contact Health Colorado, Medicaid's enrollment broker, at
303-839-2120. If you just show up at a new doctor's office, you will not be seen,
nor will Medicaid pay for that visit.
Q. Why are regular medical
visits and preventative care so important?
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Health problems may be hidden.
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The earlier health problems are found, the easier it is
to correct or stop them from becoming serious.
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Some health problems can lead to permanent disability
if left untreated.
Q. Do children and pregnant
women have a co-pay while on Medicaid?
A. No. Children under the age of 19 are co-pay exempt for
any services, and pregnant women of any age are co-pay exempt
during the pregnancy.
Note: A co-pay, or co-payment, is a small fixed amount
of money required by a health insurer to be paid by the
insured (member) for each outpatient service or
prescription.
Q. What is a medical home?
A. A medical home is not a building or house, but a way
that your child can receive ongoing, coordinated
comprehensive care. This care is by a team of health care
providers that know your child and will work within the
priorities of your family. Through your medical home, you
should be able to access the medical and non-medical services
you need.
For more information on how to strengthen your
relationship with your provider, please contact your EPSDT
outreach specialist:
Q. What do I do
if I am out of the state and need Medicaid benefits?
A. If you are temporarily out of the state
but are still a resident of Colorado, you may receive some
Medicaid benefits under certain conditions:
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It is a medical emergency.
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Your health would be endangered if you
were required to return to Colorado for the medical
care/treatment.
The doctor/hospital that treats you must
enroll in the Colorado Medicaid Program. Please have that
doctor work with our Medicaid fiscal agent so that
reimbursement is guaranteed.
Q. If I have some
health insurance but need more coverage, can Medicaid help?
A. Having health insurance coverage
DOES NOT exclude anyone from being Medicaid-eligible. Any
person who meets the Medicaid eligibility guidelines can
receive Medicaid, but you must report your other insurance
coverage. This is referred to as third-party insurance.
Medicaid will pick up the costs of
services not fully covered by your third-party insurance,
as long as the medical services are a Medicaid benefit and
you follow the rules of your third-party insurance.
Q. I have
Medicaid coverage during my pregnancy. What happens when I
have my baby?
A. You need to report the birth to
your Medicaid eligibility technician or your EPSDT
outreach specialist. When reporting a birth, the following
information is needed:
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Your name
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Your state ID # or Social Security #
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Your baby’s full name (first, middle, and
last)
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Your baby’s date of birth (DOB)
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Your baby’s gender (sex)
Q. Will my
baby receive Medicaid?
A. Yes, your baby is eligible for
all medically necessary Medicaid benefits until his/her
first birthday as long as the baby stays with you and you don’t
move out of state.
Q. Do I
continue to receive Medicaid?
A. A pregnant woman receiving
Medicaid will continue to be covered for 60 days after the
birth of her child. Women on Emergency Medicaid are not
covered beyond labor and delivery.
Q. Can Medicaid help with transportation
to a medical appointment?
A. Yes. Medicaid provides medical
transportation to and/or from non-emergency, pre-planned
medical treatment. Please contract Logisticare at
1-800-390-3182 for more information.
Please note: Logisticare only
handles transportation for the following Colorado
Counties: Adams, Arapahoe, Boulder, Broomfield, Denver,
Douglas, Jefferson, and Larimer. If you do not reside in
one of these Colorado counties, please contract your local
department of social services for additional assistance.
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